Six Strategies for Healing Medicare From a Doctor Who Knows the System Inside and Out

By Dr. David Priscal, Chief Medical Officer

We’re at a crossroads in Medicare. Physicians and nurses are burnt out. Patients are sicker. Costs have skyrocketed. But there’s hope. We can heal Medicare with innovation. Let me explain how.

Strategy #1: Re-establish the primacy of primary care

The U.S. has one of the finest emergency systems in the world. Our ambulance, medical helicopter, emergency room and urgent care providers show their expertise time and time again. We’re exceptional at triage—dealing with whatever’s in front of us for a quick fix and sending people home. That system isn’t built for the slow-moving nature of chronic conditions. But the primary care system is.

Strategy #2: Quarterly chronic-condition management

Typically, patients with multiple chronic conditions see their PCP once or twice a year. Patients can deteriorate, sometimes dramatically, in that timeframe if they’re left to manage complex care on their own. What we need instead are visits once every three months. It seems counterintuitive that seeing the doctor more can reduce costs in the long run, but we see a huge difference in both outcomes and costs.

With these quarterly visits, PCPs can do more preventive screenings, lab work and tests. They can see if the prescribed medications are working or if they’re having adverse effects. This gives PCPs the opportunity to pivot care plans quickly and as needed based on how well the patient is doing in real time rather than months after the fact.

Strategy #3: Leverage health data

Current electronic health records are not designed with providers in mind. Too often, the systems are clunky and fragmented. The documentation is onerous, sometimes taking twice as long as the visit itself.

We need a centralized electronic health records system via Medicare that aggregates all the information about a patient from their PCP, specialist, and hospitalist in one place, so staff members don’t have to waste time hunting down information and doctors don’t accidentally duplicate services.

Strategy #4: Patient-risk stratification

When PCPs know who their sickest patients are, they can deploy their resources where those resources can make the greatest impact. Whether that’s helping to arrange transportation, assist with appointment scheduling or mitigating social determinants of health like food or housing insecurity.

Of course, the only way to find out if a patient struggles with social determinants of health is to ask them. PCPs must get comfortable asking questions about housing, financial stability, food security and transportation. Nurses often know the answers to these questions about their patients already. We just need to listen to them.

Strategy #5: PCPs need more support

It’s not enough to tell PCPs they have support; we need to show them that support. Support needs to come from multiple perspectives—financial, clinical, and patient services. PCPs need to see a greater financial reward for the difficult work they do. We need to make primary care more lucrative so we can attract talented and caring providers to fill the pipeline in the short and long term.

Strategy #6: Put the patient where they’ll receive the best care

We need to consider two factors when we consider where to treat patients: where will they receive the most efficient care and where will they be the most comfortable. Sometimes the answer is a hospital or skilled nursing facility (SNF), but, increasingly, the answer is at home. We should also enable PCPs to directly admit patients to a waiting physician in a hospital or SNF.

Hospice is underused. There are many reasons for this. As doctors, we’re trained not to give up. But we’ve over-medicalized the dying process. We should bring the hospital home through home hospice care rather than admitting patients to the hospital over and over. Most people prefer to spend their final days in their homes, surrounded by loved ones.

Ilumed lights the path forward

As Chief Medical Officer at ilumed, I’m proud to say we’re working to heal healthcare and Medicare from the inside out and outside in. Our countless decades of experience make a difference. We’ve road-tested these strategies and proven they work.

Let me tell you about one patient. I’ll call her Alice. Alice overindexed in ER use, visiting different ERs all over the city. Every time, she got an X-ray or CT scan because none of the providers knew what the others had done. The costs for the visits and services added up as did the radiation from so many X-rays.

We stepped in and got Alice the care and attention she needed to reduce her dependence on ERs and improve her overall health outcomes. We connected her to one of our vetted network doctors. We ensured she had timely access to care and made it easy for her to manage her conditions with our concierge services and benefits.

We help providers extend their reach beyond the physician’s office and into the home. We meet our patients wherever they are on their healthcare journeys and make it easy for them to get the care they need and deserve. We’re designed to increase population health and health equity. We’re illuminating medicine with empathy and compassion. But don’t take these words as proof of what we do. Take our actions and our people. Our strength is in our people, and what we do speaks louder than what we say.

“The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.”